| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,236 |
2,207 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
724 |
457 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
3,259 |
3,220 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,796 |
2,763 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,130 |
2,103 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
693 |
350 |
$44K |
| D1120 |
Prophylaxis - child |
1,299 |
1,291 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,801 |
2,315 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,708 |
2,641 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
445 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
651 |
629 |
$11K |
| D4341 |
|
63 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
26 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$701.87 |
| D2740 |
Crown - porcelain/ceramic |
17 |
12 |
$0.00 |